AB0812 GASTROINTESTINAL DISORDERS IN SYSTEMIC SCLEROSIS: CLUSTER ANALYSIS AND SEVERE INVOLVEMENT PREDICTION
Authors: C. Molliere, A. F. Guedon, N. Kapel, F. Devassoigne, P. Senet Hausfater, F. Graiess, O. Fain, S. Riviere, A. Mekinian
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gastrointestinal tract (GIT) is the second most common organ involved in Systemic Sclerosis (SSc) after the skin, and is responsible for alteration of quality of life and SSc-related mortality. <h3>Objectives</h3> Since early development of organ failure is associated with poor prognosis, we need to identify risk factors associated with severe GIT involvement to prevent apparition of severe form of the disease. <h3>Methods</h3> We conducted an observational prospective and monocentric study which included 90 patients followed for SSc, from 26 December 2019 to 14 September 2021. <h3>Results</h3> We included 90 patients in this study, with 76 female sex (84.4 %) and a median age of 55.7 years (IQR 44.3-64.4). 64 had a limited cutaneous SSc (lcSSc) (71.1 %) and 26 had a diffuse cutaneous SSc (dcSSc) (28.9 %). We observed 28 patients (31.1 %) with a malnutrition and 9 patients (10 %) with at least one episode of digestive hemorrhage or small intestinal bacterial overgrowth or chronic intestinal pseudo-obstruction. The patients with malnutrition had less limited cutaneous SSc form (53.6 % vs 79 %, p = 0.027), more interstitial lung disease (57.1 % vs 27.4 %, p = 0.013) and more cardiac disease (39.3 % vs 11.3 %, p = 0.005). No patient without malnutrition died at the end of the follow-up whereas 4 patients with malnutrition died (p = 0.013). Clustering of individuals on the basis of the selected variables yielded a number of 3 clusters. Cluster 1, "Limited cutaneous systemic sclerosis" (n = 25) was only composed of lcSSc patients, presenting more frequently anti-centromeres antibodies (n = 22, 88% vs n = 9, 34.6%, p&lt;0.001 and n = 2, 6.1%, p&lt;0.001 in cluster 2 and 3 respectively). They had less frequently intestinal (n = 11, 44%) or anorectal involvement (n = 1, 4%) than cluster 2 (n = 24, 88.9% and n =16, 59.3%, p = 0.003 and p&lt;0.01, respectively). They also had a better diffusing capacity for carbone monoxide (median [IQR]: 78.50 [70.25, 84.00], p &lt; 0.001). Cluster 2 "SSc with cardio-digestive involvement" (n = 27) was composed of 20 patients with lcSSc (74.1%), less frequently than cluster 1 (n = 25, 100%, p = 0.02) and tends to be more frequently than cluster 3 (n = 19, 50%, p = 0.09). They had more frequently intestinal (n = 24, 88.9%) or anorectal involvement (n = 16, 59.3%). Regarding heart status, patients from cluster 2 had more frequently heart involvement (n = 12, 44.4 % vs n = 1, 4%, p = 0.002 and n = 5, 13.2%, p = 0.01 vs cluster 1 and 3 respectively) with higher BNP levels (median [IQR]: 91.0 [27.0, 244.5] vs 44.0 [20.0, 85.0], p = 0.03 and 27.0 [19.0, 42.0], p = 0.01 vs cluster 1 and cluster 3 respectively). They also had higher troponin levels than cluster 1 (median [IQR]: 8.5 [3.0, 21.5] vs 3.0 [2.0, 8.0], p = 0.04) and more frequently pericardial effusion (n = 7, 26.9% vs 0, 0.0% p &lt; 0.01). Regarding treatment, they had more frequently aspirin (n = 7, 26.9% vs n = 0, 0%, p = 0.02 and n = 1, 2.6, p = 0.01 in cluster 1 and 3 respectively) and more frequently statin (n = 9, 34.6% vs n = 1, 4%, p = 0.02 and n = 1, 2.6%, p &lt; 0.01). Cluster 3 "SSc with cutaneous and pulmonary involvement", composed of 38 patients, including 19 patients (50%) with diffuse cutaneous systemic sclerosis. They had higher modified Rodnan score (median [IQR]: 10.0 [8.0, 17.0] vs 3.0 [0.0, 6.0], p &lt;0.001 and 7.0 [3.0, 15.0], p = 0.04 in cluster 1 and 2 respectively). They had more interstitial lung disease according to the CT-scan compared to cluster 1 (n = 24, 61.1% vs n = 5, 20%, p &lt; 0.001) and tends to have more compared to cluster 2 (n = 24, 61.1% vs n = 11, 40.7%, p = 0.095). They also had more frequently immunosuppressive treatments than cluster 2 (n = 26, 68.4% vs n = 10, 37%, p = 0.02) but less frequently biotherapy (n = 3, 7.9% vs n = 9, 34.6%, p = 0.02) <h3>Conclusion</h3> This study reported the gastrointestinal manifestations in a cohort of 90 patients with SSc, with a predominance of gastro-esophageal involvement and in particular for the first time described a cluster analysis allowing classification of various clinical GIT phenotypes. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.